Strict blood pressure control in patients with chronic kidney disease (CKD) does not prevent progression to end-stage renal disease (ESRD), but it does decrease the risk of death after ESRD onset, researchers concluded.
Elaine Ku, MD, of the University of California San Francisco, and colleagues studied 840 CKD patients in the Modification of Diet in Renal Disease (MDRD) trial. Patients were randomly assigned to strict versus usual blood pressure (BP) control from 1989 to 1993. Investigators defined strict control as mean arterial pressure below 92 mm Hg and usual control as mean arterial pressure below 107 mm Hg. Dr. Ku’s team conducted an extended follow-up of study enrollees by linkage with the U.S. Renal Data System and National Death Index to determine ESRD and vital status through 2010.
ESRD developed in 627 patients through 2010, with a median follow-up of 19.3 years, Dr. Ku’s group reported online ahead of print in Kidney International. After ESRD onset, 142 deaths occurred in the strict BP control arm and 182 deaths occurred in the usual BP control arm, which translated into a significant 28% decreased risk of death in the strict BP control arm.
Overall, regardless of ESRD status, 212 deaths occurred in the strict BP control arm and 233 deaths occurred in the usual BP control arm, which translated into a significant 18% decreased risk of death in the strict BP control arm.